Request Medical Records

imageObtaining Copies of Your Medical Records
Release of Information (ROI)

Records can be released to anyone that the patient authorizes (in writing). A valid authorization MUST contain the following information or the request will be returned:

  • Patient's full name and date of birth (list any other names the patient may have had
  • Hospital registration number (if available)
  • Specific information being requested (e.g., type of report/information and dates of service, etc.)
  • Purpose for which the information may be disclosed
  • To whom the information is to be sent (name and address)
  • Specify authorization's expiration date if desired (see ROI form)
  • The patient's signature or a patient's legal representative‚Äôs signature. Authorizations signed by a representative must contain a copy of the guardianship papers or power of attorney
  • Date of the signature.

Requests for medical records of deceased patients require a letter of authority in addition to your signed request. The letter of authority is given to the executor of a person's estate by the Probate Court upon their death. Releasing records to anyone other than the executor is illegal, as stated in Michigan Court Law 600.2157. Please also include your phone number in case we need to contact you for additional information concerning your request.

Requests for medical records may be mailed or faxed to:
Release of Information Unit
2901 Hubbard Rd., Rm 2722
Ann Arbor, MI 48109-2435
Phone: 734-936-5490
Fax: 734-936-8571

Medical Record Release Forms

Authorization to Release Patient Information from UMHS (PDF)
To be used when the patient (or designated individual) is requesting their UMHS health information to be SENT to someone outside the institution.

Records will be sent through the U.S. Mail. Records needed for medical emergencies will be faxed directly to a physician or medical facility. Our average turnaround time for processing requests is seven business days.